Khawaja Aurangzaib, Lim Hoong Sern, Howell Neil J, Inston Nicholas
Department of Renal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK.
Department of Cardiac Transplantation, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK.
J Vasc Access. 2019 Nov;20(6):760-762. doi: 10.1177/1129729819826029. Epub 2019 Jan 31.
Left ventricular assist devices are used in heart failure patients as bridge to transplantation or increasingly as a destination therapy. These patients frequently have renal dysfunction and many reach end-stage renal failure. If haemodialysis is required, minimization of infection risk is essential. Arteriovenous grafts have been recommended for these patients due to hypothetical concerns regarding fistula maturation due to continuous flow. A case is described where a brachiocephalic arteriovenous fistula was successfully formed and used for dialysis without issue. This is one case of a small number in the literature where arteriovenous fistulas have been used in left ventricular assist device patients and it appears that concerns are unfounded and good outcomes have been reported. It would appear from this experience that approaches to vascular access for dialysis in patients with continuous-flow left ventricular assist devices are in accordance with vascular access guidelines and standard practice.
左心室辅助装置用于心力衰竭患者，作为移植的桥梁，或越来越多地作为一种终末期治疗手段。这些患者经常出现肾功能不全，许多人会发展到终末期肾衰竭。如果需要进行血液透析，将感染风险降至最低至关重要。由于担心持续血流导致动静脉内瘘成熟问题，已建议为这些患者使用动静脉移植物。本文描述了一例成功形成头臂动静脉内瘘并用于透析且无问题的病例。这是文献中少数几例在左心室辅助装置患者中使用动静脉内瘘的病例之一，似乎这种担忧是没有根据的，并且已有良好结果的报道。从这一经验来看，对于使用持续血流左心室辅助装置的患者，透析血管通路的方法符合血管通路指南和标准做法。
